But today the two were of one mind on the subject of who should lead Florida’s Agency for Health Care Administration.

Or rather, who should NOT lead it.

In a move that surprised even committee members themselves, the Health Regulation committee which Gaetz chairs, voted 4-2 to reject Gov. Charlie Crist’s nominee for the Agency for Healthcare Administration, acting AHCA Secretary Tom Arnold, the man who would implement the health overhaul in Florida.

Arnold has been viewed by many as a relatively apolitical manager, a longtime agency staffer who rose through the ranks to manage a behemoth of government that regulates hospitals and controls more than one-fifth of the state budget as administrator of Medicaid, the government-run health insurance program for the poor.
A health policy wonk, Arnold ran Florida’s Medicaid program from 2004 to 2007, when he was promoted to AHCA’s chief of staff. On Oct. 28, 2009 he was promoted to acting secretary after then-secretary Holly Benson resigned.

Amid the national health overhaul, Florida’s legislature is considering an equally radical overhaul of the state’s Medicaid program, which is growing rapidly because of the economic downturn, to consume an estimated $19 billion of the state budget.

Desperate to find ways to control those costs, the legislature is considering proposals to force some or all Medicaid customers to enroll in privately run Medicaid HMOs. Palm Beach County’s 100,000 Medicaid patients would be among those switching to an HMO.

Rep. Eleanor Sobel, D-Hollywood (2001 photo by AP/Phil Coale)

Broward County was one of the five counties that launched a Medicaid HMO pilot project last year, and Sobel said she hasn’t seen enough data to know if it should be expanded to the rest of the state.

“The hospitals spoke against the House bill. The doctors – the FMA. Nursing homes. Home health care. Everybody spoke against the plan because it was a total surprise,” Sobel said.

She felt Arnold wasn’t able to provide data to justify expanding the HMOs, and yet at the meeting, she said he endorsed expanding the pilot.

“He said he favored managed care. I don’t think that’s his job,” Sobel said. “I think that AHCA needs to realize that although they work for the governor, we are the legislature and we make the policy.”

Worse, she said, Arnold just didn’t seem enthusiastic about taking on the big job of reforming Medicaid.

“I asked him why he wanted this job and he just did not seem excited,” Sobel said. “He didn’t seem he would create certain benchmarks or bring energy to the job.”

An AHCA spokeswoman, Press Secretary Tiffany Vause, said Arnold has been extremely ill for the past week, “like, green sick,” but attended the meeting nonetheless.

Gaetz, meanwhile, said he voted against Arnold based on his slow implementation of a fraud-fighting law passed in last year’s legislative session. He said that as much as $2 billion of the $18 billion spent on Medicaid is lost to fraud.

“Secretary Arnold has been asked time and time and time again when that project is going to be implemented and today he had to say just now the contracts have been let and the effort to control fraud and abuse hasn’t even started,” Gaetz said. “It’s just a moral outrage to me that the agency hasn’t made more progress in implementing the law to prevent fraud and abuse.”

What happens next? Sobel said she’s not sure. Vause said Aronld will carry on with his duties. Acting agency heads can remain in their jobs for 12 months while awaiting Senate confirmation, and can be reappointed one term while awaiting that confirmation.

“Secretary Arnold remains focused on leading the important work of the Agency for Health Care Administration in promoting better health care for all Floridian,” his spokeswoman said. “Today’s Senate vote in the Senate Health Regulation Committee meeting was the first step in the Senate Confirmation process.”